Case 27 of 40
Someone with delirium may still be frightened after they stop calling out
Example case for staff education
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Read the case transcript
Page 1
Panel 1: Day 1
Pneumonia causes delirium with fear and repeated calling out.
Farah: Please do not leave me here.
Panel 2: Day 2
The team treats the illness and checks discomfort.
Nurse Tom: I am here to help. Tell me what feels worst.
Panel 3: Day 3
She stops calling out, but still watches the room fearfully.
Nurse Tom: She is much quieter today.
Panel 4: Day 3
A direct question reveals continuing distress.
Farah: If I speak, they will know where I am.
Panel 5: Day 3
Her fear is acknowledged without confirming the threat.
Nurse Tom: That sounds frightening. I will explain what is happening here.
Panel 6: Day 3
Oxygenation, medicines and physical discomfort are reassessed.
Ward doctor Amira: Being quiet does not tell us whether she feels safe.
Panel 7: Day 4
Familiar contact helps briefly; attention still fluctuates.
Nadia: It is Nadia. I will sit with you for a while.
Panel 8: Day 4
Care proceeds slowly with repeated explanation.
Nurse Tom: This cuff checks your blood pressure. It will squeeze, then release.
Panel 9: Day 5
Fear eases enough for her to accept help.
Farah: Stay until I have finished, please.
Page 2
Panel 10: Day 7
Attention improves; distress is assessed separately.
Ward doctor Amira: Are you still feeling frightened, even when we are talking clearly?
Panel 11: Day 7
Some threatening impressions remain.
Farah: I know you are helping, but I still feel watched.
Panel 12: Day 10
The team names delirium and discusses her experiences.
Ward doctor Amira: Illness affected how you understood what was happening around you.
Panel 13: Week 2
Physical recovery continues as discharge approaches.
Physiotherapist Lin: We will check how you manage the things you do at home.
Panel 14: Week 2
The handover includes distress as well as cognitive progress.
Nurse Tom: Tell the team if the memories are affecting sleep or daily life.
Panel 15: Week 3
Repeated assessment finds improved attention, but poor sleep persists.
Farah: The memories still feel close when I try to sleep.
Panel 16: Week 3
Her account is explored rather than dismissed.
Ward doctor Amira: Tell me which parts are troubling you most.
Panel 17: Week 5
She begins discussing the memories at her own pace.
Farah: I can talk about a little of it today.
Panel 18: Week 5
Cognitive recovery and emotional recovery have different timescales.
Nadia: We can take the next step when you are ready.
Sources
- [T01] MacLullich AMJ. Conceptualising distress in delirium. Usher teaching presentation, May 2026. Teaching slides.
- [S12] Yamaguchi, J., Hirayama, T., Sadahiro, R., Nakahara, R. and Matsuoka, H. (2023) ‘Delirium due to Trousseau syndrome treated with memantine and perospirone: A case report’, Psychiatry and Clinical Neurosciences Reports, 2(4), e159.
- [S35] Gallie, L. (2024) ‘Delirium: name it, say it: loud and clear’, Intensive Care Medicine, 50(2), pp. 314–316.
- [G01] National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management in hospital and long-term care. CG103.
Commentary
Farah stops calling out, and staff initially think she is improving. When they speak with her, they find that she is still frightened and unable to follow what is happening. She believes speaking may put her in more danger. Less agitation does not mean she feels less distressed.
The distress talk distinguishes what a person experiences from the agitation staff can observe [T01]. Ask about fear and physical discomfort, explain care and allow time for a response. Avoid arguing aggressively or confirming the threatening belief. Continue clinical assessment, including oxygen levels, medicines, pain, urinary retention and other possible causes of discomfort [G01].
By week three, repeated assessment suggests that Farah’s acute difficulty paying attention has resolved. Fear linked to memories of the admission continues and needs separate discussion. Explaining delirium may help without immediately removing the fear. Gallie’s account describes difficulties after delirium when the illness had not been clearly named and explained [S35].
Record changes in calling out, attention, drinking, reported fear and sleep separately. Improvement in one does not establish improvement in the others. Farah takes part in follow-up, but some distress remains. The case does not suggest that one reassuring conversation completes her psychological recovery.